HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date�,31� `fit(AXOQ Permit Number:
�Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
Address: 53 (3
Property Tax ID #:'540a - & io - 03 D3 -OOU - CMG
Site Plan Name:
Project Name:
New Electrical Meter Second Electrical Meter (Affidavit required)
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
00
Cost of Construction: $ &Q0 _
Generator
Lot No. 3a
Block No.
_ Windows/Doors _ Pond
Sq. Ft. of First Floor:
_ Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNEtR/I_ESSEE:
CONTRACTOR.
-�
Name F A
Address: S 8 ( Cq A-' VA c-
Name: HAek U -g u to
Company: A ( I)Uc 1, �`r i nc� —�(1C
City: 4 t�r�c-c Stater-
Zip Code: 34 9 S a Fax:
Phone No. -L-11-7-53`-7 E-
Address: lnS E . (2�Pfs!t/ ".
City: [ FL State: �
Zip Code: Fax:
Phone No
E-Mail P �� I .C.or►-L
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License Cvcc X
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie Coyfity and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with k4der or an at)Iorney before commencing work or recording our Notice of Commencement.
gna ure of Contractor - or - Owner Builder as applicable
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirrned) and subscribed before me of Physical Presence or Online Notarization
this3 i dayofyGfl .20R—,?,by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identif' a ion Produced
(Signature of N tary Public- State of Florida)
Commission No. N 1 5 Sya (Seal) �`� Y°@�GABRIELLE HICKS
,."'� ,
4o;Notary Public -State of Florida
=' �= Commission # HH 79502
My Commission Expires
February 02, 2025
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Rev 10/12/21